Guide to Controlling Cancer Pain

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What causes pain in people with cancer?

Pain is most often caused by the cancer itself. But pain can also be caused by the treatment or the tests done to diagnose cancer. You may also have pain that has nothing to do with the cancer or its treatment. Like anyone, you can get headaches, muscle strains, and other aches and pains.

Pain from the cancer

Whether you have pain and the amount of pain you have depends on the type of cancer, its stage (extent), and your pain threshold (tolerance for pain). Most of the pain occurs when a tumor presses on bones, nerves, or body organs. People with advanced cancer are more likely to have pain.

Spinal cord compression

When a tumor spreads to the spine, it can press on the spinal cord. This is called spinal cord compression. The first sign of compression is usually back and/or neck pain, sometimes with pain, numbness, or weakness in an arm or leg. Coughing, sneezing, or other movements often make it worse. If you have this pain, get help right away. This compression must be treated quickly to keep you from losing control of your bladder or bowel or being paralyzed. Your doctor can treat the cause of the pain and also give you medicine to relieve the pain. If you are treated for the compression soon after the pain begins, you can usually avoid serious outcomes such as bladder or bowel problems. Treatments usually involve radiation therapy and steroids to shrink the tumor. Or you may have surgery to remove a tumor that’s pressing on the spine, which may be followed by radiation.

Bone pain

This type of pain can happen when cancer spreads to the bones. Treatment may be aimed at controlling the cancer, or it can focus on protecting the affected bones. External radiation may be used to treat the weakened bone. Sometimes a radioactive medicine is given that settles in the affected areas of bone and helps to make them stronger. Bisphosphonates are other medicines that can help make diseased bones stronger and help keep bones from breaking. These are examples of treatments that are aimed at stopping the cause of the bone pain. You may still need opioids or other pain medicines, but sometimes these treatments can greatly reduce your pain.

Pain from procedures and surgery

Procedures and testing

Some tests used to diagnose cancer and see how well treatment is working are painful. If you and your doctors agree that such a procedure is needed, concern about pain should not keep you from having it done. Any pain you have during and after the procedure can usually be relieved. Your needs and the type of procedure to be done should dictate the kinds of medicine you get for the pain. You may be told that the pain from the procedure can’t be avoided or that it won’t last long. Even so, you should ask for pain medicine if you need it.

Surgical pain

Surgery is often used to treat cancers that grow as solid tumors, but other treatments such as radiation or chemotherapy may also be given. Depending on the kind of surgery you have, some amount of pain is usually expected. Doctors prescribe pain medicines so that you don’t have to be in pain when your surgery is over. If you tell your doctor or nurse that you’re hurting after surgery, you can almost always get medicine to treat it right away. Pain due to surgery can last from a few days to a few weeks, depending on the type of surgery.

Phantom pain

This is a longer-lasting effect of surgery, beyond the usual surgical pain. If you’ve had an arm, leg, or even a breast removed, you may still feel pain or other unusual or unpleasant feelings that seem to be coming from the absent (phantom) body part. Doctors are not sure why this happens, but phantom pain is real; it’s not “all in your head.”

No single pain relief method controls phantom pain in all patients all the time. Many methods have been used to treat this type of pain, including pain medicine, physical therapy, antidepressant medicines, and transcutaneous electric nerve stimulation (TENS). If you’re having phantom pain, ask your doctor or nurse what can be done.

Pain from other cancer treatments

Some of the side effects that occur with chemotherapy and radiation treatments may cause pain for some people. Pain can even cause some people to stop treatment if it’s not managed. Talk to your doctor or nurse about any changes you notice or any pain you have. Here are some examples of pain caused by treatment:

Peripheral neuropathy (PN)

This condition refers to pain, burning, tingling, numbness, weakness, clumsiness, trouble walking, or unusual sensations in the hands and arms or legs and feet. Peripheral neuropathy can be caused by certain types of chemotherapy, though vitamin deficiencies, cancer, and other problems can also cause it. Be sure to tell your doctor right away if you notice these kinds of problems.

You can learn more about PN by reading Peripheral Neuropathy Caused by Chemotherapy.

Mouth sores (stomatitis or mucositis)

Chemotherapy can cause sores and pain in the mouth and throat. The pain can be bad enough that people have trouble eating, drinking, and even talking.

Radiation mucositis and other radiation injuries

Pain from external beam radiation depends on the part of the body that’s treated. It can cause skin burns, mucositis (mouth sores), and scarring – all of which can result in pain. The throat, intestine, and bladder are also prone to radiation injury, and you may have pain if these areas are treated.

Last Medical Review: 06/10/2014
Last Revised: 06/10/2014